针刺外关穴的脑区激活：功能磁共振成像证据

Objective: To observe the cerebral activation of needling Waiguan (SJ5) by fMRI with the controlled studies of sham needling and needling in a sham point. Methods: Eighteen volunteers were randomly divided into 3 groups of true needling in true acupoint Waiguan (SJ5)(group A), sham needling in true acupoint SJ5 (group B) and true needling in a sham point (group C). During the stimulation, each subject received fMRI functional cerebral imaging scan. The collected data were processed by SPM2. Results: Compared with sham needling, true needling in SJ5 could activate the areas of BA8 and left cerebellum; Compared with needling in the sham point, needling in SJ5 could activate the areas of BA2 and bilateral cerebellum. Conclusion: Needling in SJ5 acupoint activated different cerebral areas compared with sham needling in the same acupoint or true needling in a sham acupoint based on the scanning of fMRI cerebral functional imaging.     

Activated and deactivated functional brain areas in the Deqi state: A functional MRI study

We compared the activities of functional regions of the brain in the Deqi versus non-Deqi state, as reported by physicians and subjects during acupuncture. Twelve healthy volunteers received sham and true needling at the Waiguan (TE5) acupoint. Real-time cerebral functional MRI showed that compared with non-sensation after sham needling, true needling activated Brodmann areas 3, 6, 8, 9, 10, 11, 13, 20, 21, 37, 39, 40, 43, and 47, the head of the caudate nucleus, the parahippocampal gyrus, thalamus and red nucleus. True needling also deactivated Brodmann areas 1, 2, 3, 4, 5, 6, 7, 9, 10, 18, 24, 31, 40 and 46.     

不同穴位皮部浅刺与常规针刺在fMRI脑功能成像中的差异

Few studies have examined the effects of different stimuli at a single acupoint using functional magnetic resonance imaging.The present study applied acupuncture at the Neiguan(PC 6),Waiguan(SJ 5),Zhigou(SJ 6) and Yanglingquan(GB 34) acupoints in healthy volunteers.fMRI was used to examine the activation of brain areas in response to different types of acupuncture(cutaneous or routine acupuncture) at each acupoint.There were no significant differences in the distribution of activation in the regions of interest between cutaneous and routine acupuncture at the Neiguan,Waiguan,and Zhigou acupoints,but some differences were observed between the two methods of acupuncture at the Yanglingquan acupoint.There were no significant differences in the intensity of induced activation between cutaneous and routine acupuncture at the Neiguan,Zhigou and Yanglingquan acupoints,but the activation intensity in the right cerebellum induced by routine acupuncture at the Waiguan acupoint was greater than that induced by cutaneous acupuncture.Results confirmed that cutaneous and routine acupuncture at the Neiguan,Waiguan,Zhigou and Yanglingquan acupoints activated different functional brain areas,and caused activation of different intensities in some areas.     

Acupuncture at Waiguan (TE5) influences activation/deactivation of functional brain areas in ischemic stroke patients and healthy people A functional MRI study

In the present study, 10 patients with ischemic stroke in the left hemisphere and six healthy controls were subjected to acupuncture at right Waiguan (TE5). In ischemic stroke subjects, functional MRI showed enhanced activation in Broadmann areas 5, 6, 7, 18, 19, 24, 32, the hypothalamic inferior lobe, the mamillary body, and the ventral posterolateral nucleus of the left hemisphere, and Broadmann areas 4, 6, 7, 18, 19 and 32 of the right hemisphere, but attenuated activation of Broadmann area 13, the hypothalamic inferior lobe, the posterior lobe of the tonsil of cerebellum, and the culmen of the anterior lobe of hypophysis, in the left hemisphere and Broadmann area 13 in the right hemisphere. In ischemic stroke subjects, a number of deactivated brain areas were enhanced, including Broadmann areas 6, 11, 20, 22, 37, and 47, the culmen of the anterior lobe of hypophysis, alae lingulae cerebella, and the posterior lobe of the tonsil of cerebellum of the left hemisphere, and Broadmann areas 8, 37, 45 and 47, the culmen of the anterior lobe of hypophysis, pars tuberalis adenohypophyseos, inferior border of lentiform nucleus, lateral globus pallidus, inferior temporal gyrus, and the parahippocampal gyrus of the right hemisphere. These subjects also exhibited attenuation of a number of deactivated brain areas, including Broadmann area 7. These data suggest that acupuncture at Waiguan specifically alters brain function in regions associated with sensation, vision, and motion in ischemic stroke patients. By contrast, in normal individuals, acupuncture at Waiguan generally activates brain areas associated with insomnia and other functions.     

太溪和丘墟穴捻针时不同脑功能区的激活

A number of previous studies of acupuncture acupoint specificity have used sham acupoints,sham acupuncture or meridian acupoints at a great distance from each other as controls in functional MRI (fMRI) experiments.However,few studies have compared different meridian acupoints within the same segment,which are associated with similarly intense needle sensations.We performed fMRI on 12 healthy young volunteers and observed differences in brain activation elicited by acupuncture of the Taixi (KI 3) and Qiuxu (GB 40) acupoints.Acupuncture was applied at the Taixi and Qiuxu acupoints,using a multiple-block fMRI design with three blocks,involving three alternations of resting and task phases.After scanning,needle sensation was assessed.The behavioral results revealed that the subjective needle sensation was similar between the Taixi and Qiuxu acupoints.The fMRI results revealed that acupuncture at the right Taixi acupoint activated the right superior temporal gyrus (BA 22),left middle frontal gyrus (BA 46) and inferior frontal gyrus (BA 45),bilateral parietal lobe postcentral gyrus (BA 2),right parietal lobe (BA 3),and left parietal lobe (BA 40).Acupuncture at the right Qiuxu acupoint activated the left superior temporal gyrus (BA 42),right parietal lobe postcentral gyrus (BA 40,BA 43),right inferior frontal gyrus (BA 47),bilateral superior temporal gyrus (BA 22),and right insula BA13.These results suggest that the right Taixi and Qiuxu acupoints activated different brain areas.     

基于功能磁共振成像的脑网络图论分析及其在阿尔茨海默病中的应用

阿尔茨海默病是以进行性智能减退为特征的中枢神经系统变性疾病,目前对其病理生理学机制尚不十分清楚。近年来,利用功能磁共振成像技术结合基于图论的复杂脑网络理论,发现阿尔茨海默病患者大脑功能网络存在局部和全局拓扑性质异常改变,这不仅为了解其病理生理学机制提供了新视角,也可能为早期诊断寻找到新的影像学标志。本文主要介绍复杂脑网络理论的基本概念,回顾近年来人脑功能网络在阿尔茨海默病中的研究进展,尤其是"小世界"网络模型的研究,并提出存在的问题及未来研究方向。     

rTMS对aMCI患者认知功能的影响及对脑网络的调控作用

目的:观察重复经颅磁刺激(rTMS)对遗忘型轻度认知功能障碍(aMCI)患者认知功能的影响及对脑网络的调控作用.方法:将30例aMCI患者随机分为rTMS组(真刺激组)15例和rTMS假刺激组(假刺激组)15例.进行蒙特利尔认知评估量表(MoCA)、临床记忆量表(CMS)测试,采集结构性磁共振成像(sMRI),同时真刺激组采集其静息态功能磁共震成像(fMRI)数据;磁刺激参数:刺激部位为左侧额叶背外侧皮质(dlPFC),强度为RMT的90％,频率为15 Hz,每日20个序列,间隔时间25 s,5d为1个疗程,连续治疗2个疗程.rTMS治疗结束后再次进行量表测试,采集真刺激组fMRI数据.比较两组治疗前后的MoCA、CMS测试结果;分析以左侧dlPFC为感兴趣区域(ROI)的功能性连接情况.结果:①rTMS对aMCI的认知能力有改善作用;②真刺激组治疗后右侧额中、左侧三角部额下回、双侧丘脑等多个脑区与左侧dlPFC功能性连接增强,右侧补充运动区等脑区连接降低.结论:高频rT-MS对aMCI患者的默认模式网络(DMN)有修复作用.     

针刺穴位的脑功能磁共振成像研究——针刺中渚穴和阳陵泉穴与大脑皮质兴奋性的关系

目的 应用功能性磁共振成像(fMRI)技术观察针刺手少阳经中渚穴(SJ3)和足少阳经阳陵泉穴(GB34)时大脑皮质兴奋区的分布特点,初步探讨经络、穴位作用的中枢机制以及针刺穴位过程中,不同针灸刺激时相对大脑皮质兴奋性的影响.方法 将42例健康受试者(右利手)随机分为SJ3和GB34两组,利用fMRI技术实时动态扫描针刺SJ3和GB34时脑功能区的变化,最终所获得的数据采用SPM2软件包分析其作用部位.结果 针刺SJ3引起的脑内主要兴奋区依次为双侧的额叶、颞叶、小脑和枕叶,针刺GB34引起的主要兴奋区依次为双侧的枕叶、小脑、额叶和颞叶.结论 针刺SJ3和GB34时均可引起双侧听觉、视觉相关大脑皮质和双侧躯体运动区大脑皮质及小脑兴奋,这可能是临床治疗相关病症的中枢作用基础.     

精神分裂症患者发病年龄与静息态脑功能局部一致性的关系

目的探讨精神分裂症患者发病年龄与静息态脑功能局部一致性(Re Ho)之间的关系。方法选取19名45~59岁符合《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)精神分裂症诊断标准的精神分裂症患者为被试。以发病年龄25岁为分界线,将患者分为25岁之前发病的早期发病患者组9名和25岁之后发病的晚期发病患者组10名,采集静息态功能磁共振数据,对比两组Re Ho值。结果相对于早期发病的精神分裂症患者,晚期发病组大脑右侧额上回处的Re Ho值显著降低(P0.01,簇大小486mm3)。同时,右侧额上回处的Re Ho均值与精神分裂症病程呈正相关,即个体病程越短,该脑区的Re Ho值越低。结论患者发病年龄越早、病程越长,对右侧额上回功能同步性越明显。     

不同MR扫描序列对脑内移植SPIO标记神经干细胞大鼠的成像对比研究

目的比较3种不同MR扫描序列对脑内移植的超顺磁性氧化铁(SPIO)示踪标记神经干细胞显示作用的优劣,找出最佳扫描方案.方法将SPIO标记的神经干细胞移植到大鼠脑内,制备动物移植模型.行MR扫描,扫描序列包括SE T2WI(TR 6 000 ms,TE 100ms)、FSE T2WI(TR 2 200ms,TE 90 ms)和GRE T2*WI(TR 500ms,TE 30 ms),分析3种扫描序列在SPIO标记神经干细胞移植大鼠脑的显像特征,并进行病理学检查对照分析.结果3种扫描序列均示靶点(标)信号强度较靶点(未)有不同程度的下降,而且靶点(标)的信号强度衰减率(PSIL)在GRE T2*WI明显高于其他序列,SE T2WI、FSE T2WI中靶点(标)之间PSIL没有显著性差异;3种扫描序列中靶点(未)的信号与正常脑组织信号没有显著性差别.结论SPIO标记的神经干细胞移植到大鼠脑内后,3种MRI扫描序列显像中以GRET2*WI最为敏感.     

Needling at the Waiguan (SJ5) in healthy limbs deactivated functional brain areas in ischemic stroke patients A functional magnetic resonance imaging study

Deactivation is common in cerebral functional imaging. However, the physiological mechanisms responsible for this phenomenon remain poorly understood. The present study analyzed 12 ischemic stroke patients, who were randomly assigned to two groups: one group underwent sham needling and true needling at the Waiguan (SJ 5) in the healthy upper limb and the other group underwent sham and true needling at a sham point. Functional magnetic resonance imaging results showed no activation points in brain tissues fo...     

Acupuncture at Waiguan （SJ5） and sham points influences activation of functional brain areas of ischemic stroke patients： a functional magnetic resonance imaging study

Most studies addressing the specificity of meridians and acupuncture points have focused mainly on the different neural effects of acupuncture at different points in healthy individuals. This study examined the effects of acupuncture on brain function in a pathological context. Sixteen patients with ischemic stroke were randomly assigned to true point group （true acupuncture at right Waiguan （SJ5）） and sham point group （sham acupuncture）. Results of functional magnetic resonance imaging revealed activation in right parietal lobe （Brodmann areas 7 and 19）, the right temporal lobe （Brodmann area 39）, the right limbic lobe （Brodmann area 23） and bilateral oc-cipital lobes （Brodmann area 18）. Furthermore, inhibition of bilateral frontal lobes （Brodmann area 4, 6, and 45）, right parietal lobe （Brodmann areas 1 and 5） and left temporal lobe （Brodmann area 21 ） were observed in the true point group. Activation in the precuneus of right parietal lobe （Brodmann area 7） and inhibition of the left superior frontal gyrus （Brodmann area 10） was observed in the sham group. Compared with sham acupuncture, acupuncture at Waiguan in stroke patients inhibited Brodmann area 5 on the healthy side. Results indicated that the altered specificity of sensation-associated cortex （Brodmann area 5） is possibly associated with a central mechanism of acupuncture at Waiguan for stroke patients.     

Dopamine transporter distribution in patients with Parkinson disease of different stages detected using single-photon emission computed tomography brain imaging

Abstract BACKGROUND: Literatures have reported that the density changes of dopamine transporter is negatively correlated with the severity degree and grading of disease condition of Parkinson disease (PD). However, the distribution of dopamine transporter in each nucleus of corpora striatum at each period is still unclear. OBJECTIVE: To observe the radioactive uptake distribution of dopamine transporter in bilateral corpora striata of patients with different stages of PD using single photon emission computed tomography (SPECT), and make a comparison with healthy controls. DESIGN: Case-control analysis. SETTING: Department of Imageology, Second Hospital Affiliated to Guangzhou University of Chinese Medicine. PARTICIPANTS: Thirty patients with PD admitted to Second Hospital Affiliated to Guangzhou University of Traditional Chinese Medicine between January and December 2005 were recruited. The involved patients, 19 male and 11 female, were aged from 36 to 80 years and with disease course of 2.5 months to 10 years. They all met the clinical diagnosis criteria of Britain Parkinson's disease Association Think Tank; Following Hoehn-Yahr grading: grade Ⅰ: unilateral morbidity; grade Ⅱ: bilateral morbidity, but without balance disorder; grade Ⅲ: bilateral morbidity, accompanied with early posture balance disorder; grade Ⅳ: severe morbidity, needs more help; grade Ⅴ: without help, only in bed or wheelchair. There were 11 patients with mild PD (grade I–Ⅱ), 9 patients with moderate PD (grade Ⅲ) and 10 patients with advanced PD (grade Ⅳ–Ⅴ). Meanwhile, 6 healthy persons were selected as normal controls. Informed consents were obtained from all the subjects. METHODS: Twenty-four hours after withdrawal of PD drugs, 30 patients with PD and 6 healthy controls took kalium perchloricum 400 mg orally. After lying down for 30 minutes, all the subjects were intravenously injected with 740 MBq 99Tc m-TRODAT-1 (Jiangsu Institute of Atomic Medicine, Batch No. 20040310) at elbow part. Following injection, image was collected using scanner for single photon emission computed tomography (ADAC Company, USA). Matrix was 64×64, each detecting head revolved 180°, 1 frame/60 s. Sixty-four frames were collected with double detecting heads, 50 K/frame. Faultages with clearest image of corpora striatum were selected. Regions of interest (ROI) of caudate nucleus, anterior and posterior putamen and thalamic region in bilateral corpora striata were radioactively counted, and mean value of radioactive counting of ROI was used as the mean value of pixel in each region of bilateral corpora striata. MAIN OUTCOME MEASURES: Comparison of radioactive uptake in each region of brain between healthy persons and patients with PD. RESULTS: Thirty patients with PD and six healthy persons who received body examination participated in the final result. Comparison of radioactive uptake in each region between healthy persons and patients with PD: ①In the healthy persons, high-density radioactive uptake was found in bilateral corpora striata; Structures of caudate nucleus, anterior and posterior putamen, and thalamus were clear with eudipleural radioactive distribution, and the background of peripheral brain tissue was very low. ②Radioactive intakes in opposite anterior and posterior putamen of patients with mild PD were significantly inferior to those in homolateral ones(70.45±3.35,87.64±2.65,t =15.82,P < 0.05). Structures of bilateral caudate nucleus and thalamus were clear with eudipleural radioactive distribution (P > 0.05). ③ Radioactive intakes in anterior and posterior putamen and thalamus of patients with moderate PD were significantly reduced as compared with healthy persons. There were significant differences in mean radioactive counting of ROI between patients with PD and healthy persons (t =5.20, P < 0.05;t =3.95,P < 0.05); The structure of opposite caudate nucleus was not very clear, radioactive distribution of opposite caudate nucleus was significantly reduced as compared with homolateral one (81.11±4.25,104.56±3.64,t = 14.65,P < 0.05). ④As for patients with advanced PD, the structure of bilateral corpora striata was not clear, radioactive intake was significantly reduced and peripheral background was heightened, even higher than the distribution of the whole corpora striatum. CONCLUSION: SPECT DAT imaging of brain can show the distribution of radioactive uptake in each region of bilateral corpora striata of patients with different stages of PD, which is helpful to diagnose and evaluate the severity of PD.     

Neuroimaging of rapid eye movement sleep behavior disorder: transcranial ultrasound,single-photon emission computed tomography,and positron emission tomography scan data

Idiopathic rapid eye movement sleep behavior disorder (iRBD), which typically develops in middle-aged individuals or later and progresses chronically, is a common clinical manifestation of Lewy body–related syndrome. It is important that combinations of neuroimaging markers in iRBD are considered for the purpose of diagnosing neurodegenerative diseases such as Parkinson disease (PD), dementia with Lewy body disease (DLB), or multiple system atrophy (MSA) at an early stage. Important advances have been made in the diagnosis of PD or DLB using imaging methods such as positron emission tomography (PET) and single-photon emission computed tomography (SPECT) scans or transcranial B-mode ultrasonography (TCS). These methods are important in clinical research, in which the identification of biomarkers for iRBD offers diagnostic opportunities and points the way to new therapeutic strategies. This review focuses on neuroimaging studies of rapid eye movement sleep behavior disorder (RBD) patients using techniques such as TCS, SPECT, and PET scans.     

Single-photon emission computed tomography (SPECT) perfusion and neuropsychological performance in mild cognitive impairment

Single-photon emission computed tomography (SPECT) is an affordable neuroimaging technique that measures cerebral perfusion and has been utilized repeatedly in aging populations. However, we are aware of no studies to date examining relationships between SPECT imaging and comprehensive neuropsychological evaluations in a clinical sample of patients with mild cognitive impairment (MCI). Participants were 124 older adults with MCI (age, M = 75.07 years, SD = 7.65; years of education, M = 14.03, SD = 3.09; 60.2% female) who underwent neuropsychological evaluations and brain SPECT scans as part of their routine clinical care. Based on SPECT interpretations, participants were grouped by suspected etiology (i.e., the neuroradiologists noted that hypoperfusion patterns were most consistent with Alzheimer’s disease, AD; frontotemporal lobar degeneration, FTLD; or other disease processes) and regional hypoperfusion (e.g., frontal, temporal, right/left hemisphere). Neuropsychological tests were grouped into domain scores (i.e., attention/processing speed, language, visuospatial, memory, executive; verbal/nonverbal). Consistent with a priori predictions, patients with an AD pattern of hypoperfusion scored lower than comparison groups on the attention/processing speed (partial χ² = 0.10) and memory (partial χ² = 0.07) composites. More patients with the AD-hypoperfusion signal met criteria for amnestic MCI (82%) than did those with a non-AD pattern (70%); this result approached statistical significance (p = .07). Contrary to hypotheses, patients whose SPECT scans were most consistent with FTLD did not underperform on the executive composite, and most regional analyses were nonsignificant. When integrating SPECT data into their clinical conceptualizations of MCI, neuropsychologists should place more weight on AD patterns of hypoperfusion, while de-emphasizing data suggestive of FTLD or regional pathology. Alternative neurodiagnostic markers may be more informative in these instances.     

A 99mTc-HMPAO single-photon emission computed tomography study of Lewy body disease

The purpose of this study was to investigate patterns of ^99mTc-HMPAO single-photon emission computed tomography (SPECT) abnormality in Lewy body disease (LBD) and to compare findings with those encountered in Alzheimer’s disease (AD). The study group comprised 20 consecutive patient referrals fulfilling clinical criteria for LBD. All patients had fluctuating cognitive impairment and ‘subcortical’ dysfunction with or without perceptuospatial and/or linguistic impairment. Six patients had asymmetrical signs of parkinsonism (three left-sided and three right-sided), and 14 patients had symmetrical features of extrapyramidal involvement. ^99mTc-HMPAO SPECT imaging was performed on LBD patients and findings compared with those of 57 patients with ‘probable’ AD and 11 normal age-matched controls. Within the LBD and AD groups, patterns of cortical and subcortical blood-flow abnormality were compared with patterns of cognitive and neurological breakdown. LBD was associated with bilateral posterior cortical blood flow abnormality, a pattern strikingly similar to that found in AD. Within the LBD group, cortical blood-flow abnormality was found to reflect patterns of neurological dysfunction (parkinsonism) indicative of subcortical involvement. In contrast, cortical blood-flow changes did not reflect patterns of neuropsychological impairment suggestive of cortical dysfunction. Within the AD group, cortical blood-flow changes were mirrored by the pattern of neuropsychological impairment. Findings support the notion that cortical blood-flow abnormality in LBD might reflect a combination of direct cortical pathology and cortical deafferentation secondary to subcortical Lewy body pathology. It would appear that ^99mTc-HMPAO SPECT imaging is of limited value in the clinical differentiation of LBD and AD. Received: 30 September 1996 Received in revised form: 6 February 1997 Accepted: 12 February 1997